European Spine Journal

, Volume 28, Issue 9, pp 2103–2111 | Cite as

Changes in pelvic anatomy after long corrective fusion using iliac screws for adult spinal deformity

  • Hiroki ObaEmail author
  • Shigeto Ebata
  • Jun Takahashi
  • Shota Ikegami
  • Kensuke Koyama
  • Hiroyuki Kato
  • Hirotaka Haro
  • Tetsuro Ohba
Original Article



Long fusion to the sacrum with iliac screws can decrease pelvic incidence (PI). Considering the physiological range of movement of the sacroiliac joint, this decrease may be relatively extreme. The purpose of the study was to determine changes in pelvic morphology after orthopedic surgery using long fusion with iliac screws, and examine the relationship between changes in PI and morphology.


We included data from 80 consecutive patients who underwent corrective surgery for adult spine deformity (72 female and 8 male; mean age: 71.1 years). We examined preoperative and early postoperative full-standing X-ray images and pelvic computed tomography of the patients and compared the following: (1) pre- and postoperative pelvic measurements including PI, (2) correlations between change of PI, iliac angle, and distance between posterior superior iliac spines (DPSIS).


After surgery, PI decreased significantly (− 3.3°, 95% confidence interval [95%CI] − 4.3° to − 2.3°, P < 0.01) and DPSIS increased significantly (+ 2.7 mm, 95%CI 1.7 to 3.8 mm, P < 0.01). By contrast, iliac angle decreased significantly (− 1.4°, 95%CI − 2.1° to − 0.7°, P < 0.01). There were significant correlations between changes of PI and iliac angle (r = 0.34, P < 0.01) and between changes of DPSIS and iliac angle (r =  − 0.44, P < 0.01).


We observed changes in pelvic morphology associated with spinal pelvic correction surgery using iliac screws and changes in pelvic incidence related to these changes in pelvic morphology. We recommend selecting pelvic anchors and surgical procedures considering potential movement of the sacroiliac joint.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Pelvic Pelvic incidence Sacroiliac joint Long fusion Adult spine deformity 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6027_MOESM1_ESM.pptx (595 kb)
Supplementary file1 (PPTX 594 kb)


  1. 1.
    Birknes JK, White AP, Albert TJ, Shaffrey CI, Harrop JS (2008) Adult degenerative scoliosis: a review. Neurosurgery 63:94–103. CrossRefPubMedGoogle Scholar
  2. 2.
    Emami A, Deviren V, Berven S, Smith JA, Hu SS, Bradford DS (2002) Outcome and complications of long fusions to the sacrum in adult spine deformity: luque-galveston, combined iliac and sacral screws, and sacral fixation. Spine (Phila Pa 1976) 27:776–786CrossRefGoogle Scholar
  3. 3.
    Maeda T, Buchowski JM, Kim YJ, Mishiro T, Bridwell KH (2009) Long adult spinal deformity fusion to the sacrum using rhBMP-2 versus autogenous iliac crest bone graft. Spine (Phila Pa 1976) 34:2205–2212. CrossRefGoogle Scholar
  4. 4.
    Schwab FJ, Lafage V, Farcy JP, Bridwell KH, Glassman S, Shainline MR (2008) Predicting outcome and complications in the surgical treatment of adult scoliosis. Spine (Phila Pa 1976) 33:2243–2247. CrossRefGoogle Scholar
  5. 5.
    Berjano P, Langella F, Ismael MF, Damilano M, Scopetta S, Lamartina C (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23(Suppl 6):587–596. CrossRefPubMedGoogle Scholar
  6. 6.
    Legaye J, Duval-Beaupere G, Hecquet J, Marty C (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Oba H, Ebata S, Takahashi J, Ikegami S, Koyama K, Haro H, Kato H, Ohba T (2019) Loss of pelvic incidence correction after long fusion using iliac screws for adult spinal deformity: cause and effect on clinical outcome. Spine (Phila Pa 1976) 44:195–202. CrossRefGoogle Scholar
  8. 8.
    Egund N, Olsson TH, Schmid H, Selvik G (1978) Movements in the sacroiliac joints demonstrated with roentgen stereophotogrammetry. Acta Radiol Diagn 19:833–846CrossRefGoogle Scholar
  9. 9.
    Kissling RO, Jacob HA (1996) The mobility of the sacroiliac joint in healthy subjects. Bulletin (Hospital for Joint Diseases (New York, NY)) 54:158–164Google Scholar
  10. 10.
    Sturesson B, Selvik G, Uden A (1989) Movements of the sacroiliac joints. A roentgen stereophotogrammetric analysis. Spine (Phila Pa 1976) 14:162–165CrossRefGoogle Scholar
  11. 11.
    Cecchinato R, Redaelli A, Martini C, Morselli C, Villafane JH, Lamartina C, Berjano P (2017) Long fusions to S1 with or without pelvic fixation can induce relevant acute variations in pelvic incidence: a retrospective cohort study of adult spine deformity surgery. Eur Spine J 26:436–441. CrossRefPubMedGoogle Scholar
  12. 12.
    Ebata S, Ohba T, Oba H, Haro H (2018) Bilateral dual iliac screws in spinal deformity correction surgery. J Orthop Surg Res 13:260. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Roland M, Morris R (1983) A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 8:141–144CrossRefGoogle Scholar
  14. 14.
    Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K (2003) Association of the Japanese orthopaedic association score with the oswestry disability index, Roland–Morris disability questionnaire, and short-form 36. Spine (Phila Pa 1976) 28:1601–1607Google Scholar
  15. 15.
    Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vleeming A, Stoeckart R, Volkers AC, Snijders CJ (1990) Relation between form and function in the sacroiliac joint. Part I: clinical anatomical aspects. Spine (Phila Pa 1976) 15:130–132CrossRefGoogle Scholar
  17. 17.
    Vleeming A, Volkers AC, Snijders CJ, Stoeckart R (1990) Relation between form and function in the sacroiliac joint. Part II: biomechanical aspects. Spine (Phila Pa 1976) 15:133–136CrossRefGoogle Scholar
  18. 18.
    Shibata Y, Shirai Y, Miyamoto M (2002) The aging process in the sacroiliac joint: helical computed tomography analysis. J Orthop Sci 7:12–18. CrossRefPubMedGoogle Scholar
  19. 19.
    Rosatelli AL, Agur AM, Chhaya S (2006) Anatomy of the interosseous region of the sacroiliac joint. J Orthop Sports Phys Ther 36:200–208. CrossRefPubMedGoogle Scholar
  20. 20.
    Kampen WU, Tillmann B (1998) Age-related changes in the articular cartilage of human sacroiliac joint. Anat Embryol 198:505–513CrossRefPubMedGoogle Scholar
  21. 21.
    Alderink GJ (1991) The sacroiliac joint: review of anatomy, mechanics, and function. J Orthop Sports Phys Ther 13:71–84. CrossRefPubMedGoogle Scholar
  22. 22.
    Jean L (2014) Influence of age and sagittal balance of the spine on the value of the pelvic incidence. Eur Spine J 23:1394–1399. CrossRefPubMedGoogle Scholar
  23. 23.
    Vrtovec T, Janssen MM, Likar B, Castelein RM, Viergever MA, Pernus F (2012) A review of methods for evaluating the quantitative parameters of sagittal pelvic alignment. Spine J 12:433–446. CrossRefPubMedGoogle Scholar
  24. 24.
    Roussouly P, Pinheiro-Franco JL (2011) Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20(Suppl 5):609–618. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lee JH, Na KH, Kim JH, Jeong HY, Chang DG (2016) Is pelvic incidence a constant, as everyone knows? Changes of pelvic incidence in surgically corrected adult sagittal deformity. Eur Spine J 25:3707–3714. CrossRefPubMedGoogle Scholar
  26. 26.
    Tseng C, Liu Z, Bao H, Li J, Zhao Z, Hu Z, Qiu Y, Zhu Z (2019) Long fusion to the pelvis with S2-alar-iliac screws can induce changes in pelvic incidence in adult spinal deformity patients: analysis of predictive factors in a retrospective cohort. Eur Spine J 28:138–145. CrossRefPubMedGoogle Scholar
  27. 27.
    Moon JW, Shinn JK, Ryu D, Oh SY, Shim YS, Yoon SH (2017) Pelvic incidence can be changed not only by age and sex, but also by posture used during imaging. Korean J Spine 14:77–83. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Hiroki Oba
    • 1
    • 2
    Email author
  • Shigeto Ebata
    • 1
  • Jun Takahashi
    • 2
  • Shota Ikegami
    • 2
  • Kensuke Koyama
    • 1
  • Hiroyuki Kato
    • 2
  • Hirotaka Haro
    • 1
  • Tetsuro Ohba
    • 1
  1. 1.Department of Orthopaedic Surgery, School of MedicineUniversity of YamanashiChuoJapan
  2. 2.Department of Orthopaedic Surgery, School of MedicineShinshu UniversityMatsumotoJapan

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